Household costs and health-related quality of life of childhood multidrug-resistant TB in Western Cape, South Africa

Background: Multidrug-resistant TB (MDR-TB) in children remains a major public health challenge. Although treatment is free of direct charge in many countries, it can impose substantial indirect and non-medical costs on affected households. Evidence on the economic burden of childhood MDR-TB on families remains limited.

Methods: A cross-sectional household survey was conducted in the Western Cape, South Africa, among 45 households with a child <15 years who initiated MDR-TB treatment between 2018 and 2021. Socio-economic status, costs of accessing care, and health-related quality of life (HRQoL) were assessed and linked to health service utilisation data to estimate household-level costs.

Results: The median total cost per household was ZAR 7,443 (US$504) per episode of care (interquartile range: ZAR 4,119-13,207), with indirect costs accounting for the largest share of household costs. Twenty-three (51.1%) of households incurred catastrophic health expenditure, defined as >20% of annual household income. Costs increased with hospital-based care, longer treatment duration, and more frequent caregiver visits. The HRQoL of children was generally high, though not uniformly distributed.

Conclusion: Childhood MDR-TB places substantial financial burden on already vulnerable households. Economic evaluations and care models should incorporate household costs and consider strategies to reduce the indirect burden of treatment on families.